<?php $this->load->view('webindex/config/header-default'); ?>
<div class="menu-list">
	<ul>
		<li><b>How To Joint Us</b></li>
		<?php if (@$submenu):?>
			<?php foreach ($submenu as $row):?>
				<li><a href="<?php echo site_url()?>webindex/content/7/<?php echo $row['id_submenu']?>"><?php echo $row['nama_submenu']?></a></li>
			<?php endforeach?>
		<?php endif?>
	</ul>
</div>
<div class="content-right">
	<div class="title">
		<img src="<?php echo base_url(); ?>lib/frontend/img/foot.png" />
		<p>Formulir Pendaftaran</p>
	</div>
	<div class="description-content">
		<?php $success = $this->session->flashdata('success');?>
		<?php if ($success):?>
			<div class="alert-sukses">
				Data telah tersimpan
			</div>
		<?php endif?>
		<?php $error = $this->session->flashdata('error');?>
		<?php if ($error):?>
			<div class="alert-error">
				Data gagal tersimpan atau captcha anda masukan masih salah
			</div>
		<?php endif?>
		<form class="formulir-css" id="formPendaftaran" method="post" action="<?php echo site_url() ?>formulir/save" enctype="multipart/form-data">
			<table border="0">
				<tr>
					<td colspan="3"><b>DATA PEMOHON</b></td>
				</tr>
				<tr>
					<td>Nama<span style="color:red">*</span></td>
					<td>:</td>
					<td><input type="text" name="nama_pendaftar" size="60" required ></td>
				</tr>
				<tr>
					<td>No. KTP<span style="color:red">*</span></td>
					<td>:</td>
					<td><input type="text" name="no_identitas" size="50" required></td>
				</tr>
				<tr>
					<td>Alamat</td>
					<td>:</td>
					<td><textarea name="alamat_pendaftar" style="resize:none" cols="50" rows="3"></textarea></td>
				</tr>
				<tr>
					<td>Telephon<span style="color:red">*</span></td>
					<td>:</td>
					<td>
						<table>
							<tr>
								<td>1.</td>
								<td><input type="text" name="telp_1_pendaftar" value="" maxlength="15" required></td>
							</tr>
							<tr>
								<td>2.</td>
								<td><input type="text" name="telp_2_pendaftar" value="" maxlength="15" ></td>
							</tr>
						</table>
					</td>
				</tr>
				<tr>
					<td>Fax</td>
					<td>:</td>
					<td><input type="text" name="fax_pendaftar" value=""></td>
				</tr>
				<tr>
					<td>Email<span style="color:red">*</span></td>
					<td>:</td>
					<td><input type="email" name="email_pendaftar" size="30" required></td>
				</tr>
				<tr>
					<td colspan="3">&nbsp;</td>
				</tr>
				<tr>
					<td colspan="3"><b>LOKASI USAHA</b></td>
				</tr>
				<tr>
					<td>Alamat<span style="color:red">*</span></td>
					<td>:</td>
					<td><textarea name="alamat_lokasi" cols="50" rows="3" style="resize:none" required></textarea></td>
				</tr>
				<tr>
					<td>Telp Lokasi<span style="color:red">*</span></td>
					<td>:</td>
					<td><input type="text" name="telp_lokasi" value="" maxlength="15" required></td>
				</tr>
				<tr>
					<td>Ukuran Tempat Usaha<span style="color:red">*</span></td>
					<td>:</td>
					<td>
						<table>
							<tr>
								<td>Lebar Depan</td>
								<td>:</td>
								<td><input type="number" name="lebar_lokasi" value="" size="3" maxlength="3" placeholder="meter" required></td>
							</tr>
							<tr>
								<td>Panjang</td>
								<td>:</td>
								<td><input type="number" name="panjang_lokasi" value="" size="3" maxlength="3" placeholder="meter" required></td>
							</tr>
						</table>
					</td>
				</tr>
				<tr>
					<td>Estimasi Anggaran<span style="color:red">*</span></td>
					<td>:</td>
					<td>Rp. <input type="text" name="estimasi_anggaran" required></td>
				</tr>
				<tr>
					<td>Upload Pas Foto<span style="color:red">*</span></td>
					<td>:</td>
					<td><input type="file" name="files[]" required></td>
				</tr>
				<tr>
					<td>Upload Gambar Denah Lokasi<span style="color:red">*</span></td>
					<td>:</td>
					<td>
						<input type="file" name="files[]" required><br/>
						<i>upload denah harus berbentuk .zip yang berisi gambar-gambar denah dari lokasi</i>
					</td>
				</tr>
				<tr>
					<td colspan="3">&nbsp;</td>
				</tr>
				<tr>
					<td colspan="3">Catatan : <i>Sertakan foto rencana tempat usaha tampak depan, belakang, samping kanan dan kiri serta dalam ruangan usaha tampak dari 4 sisi.</i></td>
				</tr>				
				<tr>
					<td colspan="3">&nbsp;</td>
				</tr>
				<tr>
					<td>Captcha</td>
					<td>:</td>
					<td>
						<table>
							<tr>
								<td colspan="3"><input type="text" name="secutity_code" required></td>
							</tr>
							<tr>
								<td colspan="3"><?php echo $datacaptcha ?></td>
							</tr>
						</table>
					</td>
				</tr>
				<tr>
					<td>&nbsp;</td>
					<td>&nbsp;</td>
					<td><input type="submit" name="submit" value="Simpan" /></td>
				</tr>
			</table>
		</form>
		
	</div>
</div>
<div id="clear-line"></div>
<div class="contaiter-slide-produk">
	<ul id="slideProduk" class="ui-jcoverflip">
		<?php if (@$logoLabel):?>
			<?php foreach ($logoLabel as $row):?>
				<li class="ui-jcoverflip--item"><a href="#"><img src="<?php echo base_url(); ?>upload/pages/<?php echo $row['file_page']?>" /></a></li>
			<?php endforeach?>
		<?php endif?>
	</ul>
</div>
<?php $this->load->view('webindex/config/footer'); ?>